Commissioning alternatives to hospital Dr Seth Rankin Rob Persey Structure • Introduction to the Community Ward in Wandsworth. • Platform for other admission diversion schemes. • Not just health and social care – everybody’s responsibility! What is a Community Ward? • A new way to structure Community Service. • Multidisciplinary Platform for providing integrated health & social care in the community. • Towards developing a comprehensive service designed to deliver acute & chronic healthcare at home. An Analogy… Hospitals Community Wards Acute & Chronic Patients Acute & Chronic Patients Home-based A&E, MAU, Inpatient, etc MDT ‘Ward Rounds’ Paper-based MDT Ward Rounds Bedside & Paper Nurses Doctors Social Workers Pharmacists MDT input… Nurses – CMs, ANPs, DNs Doctors – GPcw, Geriatricians Social Workers Pharmacist MDT input – Mental Health, Palliative Care, Specialist Nurses, Addiction Services, Age UK, Carers Why have a Community Ward? • • • • • • Improve patient’s experience and increase capacity for home-based healthcare Reduce unnecessary admissions. Assist integration, productivity & responsiveness of community services. Platform for Integration of Social and Health Services. Care often not equitable across an area. To prevent admissions and facilitate discharge we need to provide a safe place for patients to go. The Basics: • Daily ‘activity rounds’ with core team • Weekly MDT ward rounds with ‘everyone’ • Joint visits (GPcw, CM & SW) for ‘chronic’ patients • ANP or GPcw visits for ‘acute’ patients • In-reach into hospitals to facilitate early discharge • Patient information entered directly into GP’s computer (EMIS) via remote connection Key elements MDT ‘Rounds’ GPcw (Core Team) • DNs • ICT • Specialist Nurses • Mental Health • Dementia Addiction • AgeUK • Palliative ...and more Geriatricians Integrated IT (EMIS, iClip, Framework i) Patient Pathways: Community Ward Primary Care Acute Intervention Social Services Secondary Care • ANP • GPcw SPoC Ward Clerk Chronic Management Ambulance Service Voluntary Services Secondary Care (IP or OP) • Community Matron • GPcw • Social Worker Predictive Modelling GP Lessons Learned: • • • • • • • • Patients prefer to be at home. Massive duplication of services in the community. MDT meetings & integration help address this. Integrating with Social Services is enabled by MDT meetings. GPs can be useful. ‘Ward Clerk’ role is vital. IT integration can be cobbled together. None of this is easy. Challenges: • • • • • • • • • • Ongoing Funding linked to Evidence of Effectiveness. Transition from Pilot to Establishment. Staffing levels difficult to maintain – CMs & GPs. Line Management Structure & Systems. Project/Change Management resources. IT integration – technical difficulties & lack of will. Predictive Modelling. Rooms & Estates Issues. Internal ‘marketing’ – hearts & minds of existing staff. External ‘marketing’ - GPs, Secondary Care, Social Services, Ambulance, OOH providers, voluntary sector. Exploring other admission diversion schemes • Developing an integrated assessment and response service (IARS): – Improve transition for patients between hospital and community services – Reduce acute hospital activity, including unnecessary admissions – Maximise independent living to support people ‘to do’ rather than ‘be done to’ – Reduce and delay admissions into residential/nursing care – Develop dementia friendly services IARS – what’s in scope? (list not exhaustive!) • Community Ward as platform for other interventions: – Reablement and Intermediate Care – Telecare and telehealth services – Equipment – Integrated Falls Service – Community Therapies – Out of Hours service – Specialist Day Services 3 workshop questions ?!?! … • Practically how do we implement this on the frontline – can it work as a platform for integrated health and social care delivery? • Will we ever realistically see a reduction in hospital admissions? • (How) can we facilitate the transfer of resources from the acute to the community sector?