April 2014 - Northumberland, Tyne and Wear NHS Trust

Report
Transforming Services
Media briefing
Northumberland, Tyne and Wear
NHS Foundation Trust
Strategic Direction
The environment in which we work:
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Quality
Sustainability
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Cost
We have to improve quality for
the patient
We have to reduce our overall
cost of doing so
We aim to improve clinical
effectiveness thus reducing
reliance on inpatient beds
We have to create sustainable
services, delivered by
sustainable organisations,
operating in a sustainable
system
What our partners have told us:
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We have to get much better
at what we do and how we do
it
We have to get better at
listening and acting on what
people are telling us
We have to be consistently
good across all our services
We need to get the patient
quickly into the right services
and then deliver the best
outcome possible
What patients and carers have told us:
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Patient
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They want high-quality, safe
care close to home
They want inpatient services
to be of a high standard
They want services designed
and operated around the
needs of patients
They want the patient to be
truly ‘at the centre’
They want to gain and re-gain
independence, as far as
possible
The Service Model
Request for Help
Information & Advice
Initial Response
Initial evaluation regarding nature, risk, complexity and urgency of the problem
More Intensive Packages of Care
Hospital
Signposting to principal service pathway for assessment and formulation
Psychiatric Intensive Care
Treatment Intensity
Low Security
Specialist Ward
Crisis Beds
PICU
Environment
Acute Ward
Intermediate
beds
In the Community
Low Security
Intermediate Facility
Challenging
Crisis Bed
Behaviour
Acute Ward
Mild severe
non psychotic
Very
severe &
complex
nonpsychotic
Psychosis
Dementia
Assessment
Intensive Home
Treatment
At Home
Intensive
Home
Home
Etc.
Challenging
Behaviour
Treatment
Assessment Formulation
& Treatment Planning
Crisis Assessment
Discharge
Neuro disability
Learning
Disability
Children &
Young
People
Substance
Misuse
Scaffolding
Medium Security
Service Model Review Principles
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You should reach us, quickly and simply
The earlier the better
To get the right help and care, safely and easily
From our flexible and skilled workforce
In collaboration with you and your carers and partnership
organisations
• So that you can gain / re-gain independence, as far as
possible
• By making smooth and sustainable steps forward
• Reaching us again, simply and quickly
Urgent Care - Initial Response Team
Universal Crisis Team
Initial Response Team
Rapid
Response Nurses
REQUEST
FOR HELP
Info Collection
& routing
Triage & Action
Home Based Treatment
Flexible
Working
Assessment
Gatekeeping
ADVICE AND SCAFFOLDING
Community Care / Specialist Care
ROUTING
You should reach us, quickly and
simply. The earlier the better
The need to realign and balance resources:
At any time, 3% of patients are consuming 52% of resources
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Inpatient
Services
Community
Services
£92.2M
£84.8M
NTW Whole
costs
NTW Whole
costs
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We spend in inpatient areas to
the detriment of community
services
A few patients consume much
of the resource
Many inpatients perhaps don’t
need to be, but we lack the
necessary community services
to support them out of hospital
We need to balance resources
to maximise quality over cost
Principal Community Pathways (PCP)
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 patient
• Double current productive time of community services by redesigning
current systems and reducing bureaucracy
• Enhance the skills of our workforce
• Improve ways of working and interfaces with partners
• Reduce reliance on inpatient beds and enable cost savings
This is not achievable in isolation and to be successful we need it to be part
of integrated work with partners
What will be different?
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Current Experience
There are lots of confusing ways to access
services
Most non urgent services operate Monday
to Friday 9 – 5, and there are waiting lists
Treatment episodes cannot always be
linked to an outcome or a nice guidance
recommended treatment, staff often have to
refer to others for treatment
Patients can bounce around the system
Staff time is taken up with typing, driving
and admin
Patients stay in services for a long time due
to lack of joined up working and support to
help them recover
Patients don’t want to be discharged
because it’s hard to get back into services
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Our Commitment
There will be a single point of access for all
referrals
Most non urgent services will work from
8am – 8pm, and waiting lists will be minimal
Treatment packages will be evidence based
and staff will be trained to deliver a broader
range of nice recommended interventions
Principle of ‘no Bouncing’
Staff will have twice as much time to spend
with patients
Services 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.
What does this mean for inpatient
services?
Our aim for in-patient services is to ensure that when service users
need to be in hospital, they are looked after in
• an appropriate environment,
• which is properly staffed, and
• delivers effective interventions which are focussed on recovery
• supporting people to step down out of hospital, as soon as their
needs allow
What does this mean for inpatient
services
• Currently the Trust uses less beds than it has available and we have
‘spare capacity’
• The amount of ‘spare capacity’ is expected to increase as significant
improvements are made to community services
• So, overall across the Trust we are looking to reduce inpatient
provision for adults and older people’s services
• Any major changes will be subject to public involvement and
consultation in partnership with our Clinical Commissioning Groups
The travel issue…
• Across NTW it is not unusual for people to travel to the right inpatient
services.
• Every patient is asked about travel for them and their carers/family on
admission
• Wards have a number of resources available to help families and
patients, including ward cars, access to information etc.
• We are working on ways to ensure local staff
can keep in touch without too much travel

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