Outline Programme for Unscheduled Care Deep Dive for Portsmouth and South East Hampshire System 13 November 2013 Venue: Meeting Room, Trust Headquarters, F Level Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust 8.15 – 8.30 Arrival at PHT Trust Headquarters Office, F Level QAH 8.30 – 8.45 Welcome from Dr Jim Hogan (Chief Clinical Leader for Portsmouth CCG and Chair of System Sustainability Board) and Ursula Ward (Chief Executive Portsmouth Hospitals Trust) 8.45 – 9. 30 CCGs/Urgent Care and System Sustainability Board Dr Jim Hogan (Chief Clinical Leader Portsmouth CCG), Dr Barbara Rushton (Clinical Chair of South East Hampshire CCG and Chair of Urgent Care Design Board), Alex Berry (Chief Commissioning Officer Portsmouth, South East Hampshire and Fareham and Gosport CCGs) 9.30 – 10.15 Portsmouth Hospitals Trust Ursula Ward (Chief Executive Portsmouth Hospitals NHS Trust), Ben Lloyd (Director of Finance and Deputy Chief Executive), Cherry West (Chief Operating Officer) 10.15- 10.30 Coffee 10.30 – 12.00 Visit ED, integrated Urgent Care Centre, Medical Assessment Unit and Ambulatory Care Unit – Rick Strang PHT 12.00 – 12.30 Lunch 12.30 – 1.15 Ambulance and 111 provider Sue Byrne (Chief Operating Officer South Central Ambulance Service), Neil Cook (Area Manager, South Central Ambulance Service) Linda Lambourne (Assistant Director for 111) 1.15 – 1.45 Care UK provider of OOHs and Minor Injuries/Illness 1 Penny Daniels, (Hospital Director Care UK –ISTC St Mary’s), Tim Wright (Medical Director) and Andrew Russell (OOH/PHL) 1.45 – 2.00 Break 2.00 - 2.45 Southern and Solent Community Providers Sue Harriman (Acting Chief Executive), Gethin Hughes (Integrated Services Divisional Director), Southern Health Community Foundation Trust Alex Whitfield (Chief Operating Officer, Solent NHS Trust) 2.45 – 3.15 Portsmouth City Council and Hampshire County Council Gill Duncan (Director of Adult Services HCC) and Karen Ashton (Strategic Commissioning Director – Joint Commissioning HCC) Julian Wooster (Strategic Director & Director of Children’s Services, Portsmouth City Council), Rob Watt (Head of Adult Social Care) and Angela Dryer (Asst Head of Adult Social Care) (Portsmouth Social Services) 3.15 – 3.45 CCGs Clinical lead and Chief Officer Dr Jim Hogan , Innes Richens (Chief Operating Officer Portsmouth CCG), Dr Barbara Rushton, (Chair of South Eastern CCG) Alex Berry and Jacqueline Cotgrove (Director of Operations Wessex Area Team) 3.45 Coffee and close 2 Briefing note: 13 November 2013 Managing unscheduled care across Portsmouth & South East Hampshire Contents Background information 2 Executive summary 5 Introduction and overview 6 Developing out-of-hospital care 7 NHS 111 and related issues 9 Emergency department attendances and related issues 9 Winter planning 16 Governance 17 Outstanding issues 18 3 Background information. Portsmouth & South East Hampshire health and social care system serves more than 650,000 people and covers the area shown below: 4 Key organisations in the health and social care system are: • NHS Fareham & Gosport Clinical Commissioning Group (F&G CCG) • NHS South Eastern Clinical Commissioning Group (SHE CCG) • NHS Portsmouth Clinical Commissioning Group (P CCG) • Portsmouth Hospitals NHS Trust (PHT) • South Central Ambulance NHS Foundation Trust: Ambulance and 111 (SCAS) • Solent NHS Trust (ST) • Southern Health NHS Foundation Trust (SHFT) • Care UK [Out of Hours and St Mary’s Minor Injuries service] (CUK) • Portsmouth City Council (PCC) • Hampshire County Council (HCC) • South Eastern Hampshire Primary Care Alliance (SEHGPA) • Fareham and Gosport Primary Care Alliance (FGGPA) • 73 GP Practices The major acute hospital for the area is the Queen Alexandra Hospital at Cosham. Details of local facilities include: Facility Location Available Overnight Other facilities Provider(s) beds Queen Alexandra Cosham 874 general and acute Full range of DGH PHT Hospital (includes 17 ITU and services 52 Paeds) Gosport War Memorial Gosport 39 general and acute Accident Treatment PHT Hospital Centre Rapid Assessment SHFT 5 Unit/community/rehab Oak Park Community Havant None Rapid Assessment Unit SHFT Clinic Petersfield Hospital Petersfield 42 general and acute Rapid Assessment PHT & SHFT Unit/community/rehab beds St Mary’s Hospital Milton 16 general and acute Community beds Solent Guildhall Walk Healthcare Portsea Island None CUK Centre Another 25 beds (including Continuing Health Care and end of life care beds) are available in Jubilee House together with 10 rehabilitation/reablement beds at The Grove Unit. Both units serve Portsmouth City and are managed by Solent NHS Trust. There are also 30 places in total at Harry Sotnik House, Cams Ridge Care Home, Edenvale Nursing Home and Wenham Holt Nursing Home. In addition to these physical facilities the system has many health and social care staff working in the community. These community services include three Integrated Care Teams: a long-running and very successful scheme in Central Portsmouth plus two new pathfinder schemes in Bordon and Hayling Island. Integrated Care Teams typically include local GPs/Practice teams, community geriatricians, community nurses, social care staff, occupational therapists and physiotherapists, older people’s community mental health teams, care co-ordinators and healthcare assistants 6 2. Executive Summary 2.1 Portsmouth & South East Hampshire health and social care system has devoted significant effort and resource in recent times to developing a coherent, system-wide strategy and model for out-of-hospital care. The result is that the system operates extremely efficiently in comparison to other local and national systems. 2.2 The health and care system successfully supports more individuals safely in their normal place of residence (and hence admits significantly fewer non-elective patients than other systems) and has managed to reduce the number of such admissions over the course of the last five years when systems across the south of England have seen increases averaging 21%. 2.3 Indeed the local health system can demonstrate very strong performance across a range of indicators from the effectiveness of 111 and the ambulance service to the effectiveness of community and local authority partners in limiting delayed transfers of care. 2.4 The system has achieved this level of performance by working in partnership, through a focus on patient experience and quality, and through investment in both out-of-hospital and in-hospital systems. A new COMPACT between the 3 local CCGs has enabled a systematic review and alignment of out-of-hospital and in-hospital services across the patch, reducing duplication and complexity. Many of the improvements flow from a Whole System Unscheduled Care Plan underpinned by a detailed action plan developed with ECIST. 2.5 Despite its many successes the system has, over the course of the last 18 months, consistently failed to deliver the ED four hour wait. With support from ECIST the system has identified four key reasons for this: rising attendances at the ED; the need for greater flexibility in the acute trust clinical workforce; the need for improved patient flow within the acute hospital; the need to accelerate safe patient discharge into the community. 7 2.6 During the past six months the health and care system has focused on improving each of these areas so that ED 4 hour performance improves to match other elements of local unscheduled care performance. The Trust failed to meet the 95% target for four hour waits for most of the past six months but at the time of writing has achieved it for the month of October and is currently among the top 10% of NHS Trusts in England for performance against this indicator. Whilst this achievement deserves to be celebrated, all system partners wish to ensure that this performance level is sustained over the long term. 3. Introduction/overview 3.1 Portsmouth & South East Hampshire health and social care system has devoted significant effort and resource in recent times to developing a coherent, system-wide strategy and model for out-of-hospital care. 3.2 Its approach is performance-focused and data-driven, with strong CCG leadership allied to clear lines of accountability and good governance. Investments are designed to deliver maximum impact and a better patient experience. 3.3 As a result the health system admits relatively few patients unnecessarily in comparison to other areas. Non-elective admissions at Portsmouth Hospitals NHS Trust are currently 3.8% lower than last year, against 0.5% growth nationally. 1 Emergency admissions between 2007 and 2012 grew by just 3%, compared to 21% across the South of England. 2 The admission rate for assessed patients with a high risk condition (e.g. heart failure, respiratory disease, dementia) is 20% compared to a national rate of around 30%. The three local CCGs are in the top 5% nationally for unplanned admissions for conditions that should not need hospitalisation.3 1 SUS data 2 Kings Fund review of urgent and emergency care 8 Developing out-of-hospital care Despite this good benchmarked performance, there is scope for further improvement. Audits and other studies have indicated that 15% of current non-elective admissions to Portsmouth Hospitals NHS Trust could be managed more appropriately in other settings. As an example, root cause analysis and a recent patient survey highlighted that nearly half of all attendees do not consider calling 111 or their GP before they attend A&E CCG strategic commissioning plans therefore emphasise the need to provide as much care as possible outside hospital, and to reduce unnecessary hospital attendances and admissions. Recent initiatives include: Integrated Community care teams. Two pathfinder schemes for integrated health and social care teams, each covering around 30,000 people, started in August 2013. Common assessments, a single patient record, and multi-disciplinary care planning across primary, community and social care provide seamless access to a range of services on an individualised pathway. Re-ablement and rehabilitation service. The Portsmouth service provides seven day coverage.