Community Hospitals as the hubs of popula on health systems
An exci ng future without beds?
Jen Lambert Sister Maryport Hospital
Vanessa Connor Integrated Care Community Manager
Professor John Howarth Deputy CEO, Cumbria Partnership Founda on Trust, Professor of Primary Care UCLAN
NHS activity in the last 10 years (national)
Admissions via Outpa ents Total admissions A&E up 55% up 50% up 50%
Elec ve Diagnos c ac vity Demand is steadily admissions up 100% up 75% increasing in our ‘Na onal Illness Service’ – these graphs are just the last 10 years Current National Context – The Money
There isn’t enough money – demand for services and associated costs will far outstrip available resources The Ages of Man 17th Century Dutch
Our over 85s will double in the next 20 years Maryport Rise in over 65 Popula on over 20 years
Maryport practice locality - Projected population trend
4500 The over 85s will rise from 288 to 662 4000 662 3500 446 671 3000 456 2500 836 288 689 2000 349 513 1500 993 965 Persons ('000s) Persons 1000 643 1137 500 758 976 0 2008 2019 Year 2029 65 - 69 70 - 74 75 - 79 80 - 84 85+ Our response so far… How can we cope? Our tradi onal tools such as performance management aren’t enough, even Lean approaches cant save us – we need to get to the ‘third curve’ Assets and partnerships Working with mobilised Con nuous communi es improvement, and co-produc on LEAN with pa ents and their families Performance management approaches
We need a new paradigm for healthcare
moving from reac ve medical care to a popula on health system (built on co-produc on)
North Cumbria was one of the ‘Success Regime’ areas: Our community hospitals were part of a wide ranging review and public consulta on. The agreed proposal:
• Removes the beds from Maryport, Alston and Wigton community hospitals
• Keeps the hospitals open
• Keeps 40% of money released in the local area
• Was strongly opposed by thousands of people in local communi es Maryport Community Hospital
Working with the community to find a be er way
Our approach:
• We created a Maryport Alliance –
local ac on groups, League of Maryport ‘Alliance’
Friends, clinical teams, GPs Building a Population Health System for Maryport
A proposal to the Success Regime
• A number of challenging but construc ve mee ngs including 3 deep dives into end of life care
• Reframing the issue from beds to Version 1.6 Draft 4.11.16 addressing the popula on health
issues and figh ng for investment Authors: to address the local popula on Dr Dan Berkley, Dr Brian Money - Maryport Health Services Maurice Tate - Maryport League of Friends health issues Sharon and Bill Barnes - Save our Beds (SOBS) Claire Molloy, Vanessa Connor, Prof John Howarth - CPFT Kate Whitmarsh, Ann-Marie Steel - Ewanrigg Local Trust tbc - Adult Social Care Jen Lambert, Sue Hooper, Rev Ken Wright – Victoria Cottage Hospital, Maryport Anne Greggains, Celia Underwood – Patient Participation Group Linda Radcliffe, Sharon Stamper – Maryport Town Council
Our approach:
Together we wrote an alterna ve proposal making Maryport hospital the hub of a new popula on health system We started with understanding the needs but also mapping the assets:
• Maryport is one of the most deprived communi es in Cumbria
• In Ewanrigg 54% of Year 6 pupils are overweight or obese (source Public Health England). These are the highest rates in the whole of England.
• Long term unemployment is double the na onal average.
• Income depriva on is 25.7% c.f. England average of 14.7%
• Deaths from all causes under 75 is 46% higher than the England average. Maryport Facts
• There is large scale movement of people for healthcare for a community with poor public transport links and low car ownership. 26% of all households do not have access to a car (46% in Ewanrigg ward).
• Over 50% of the Maryport health budget leaves the town to pay for acute hospital care.
• In 2014/15 there were 29,572 journeys out of the town for care broken down as follows:
Ø 22,208 Outpatient appointments Ø 3496 A&E attendances Ø 1,995 non-elective admissions Ø 1,873 elective admissions
Maryport Facts
• The community hospital has 13 beds
• It costs £963,780 to run of which £623,021 relate to nursing costs
• Last year there were 252 admissions so each admission costs about £4000
• Until recently there was a crisis around staffing across all our community hospitals felt strongly in Maryport with an RGN vacancy rate of over 60% (more recently recruitment in Maryport improved++ due to work of Maryport Alliance)
• There are 200 residential and nursing home beds in Maryport plus 79 extra care housing units
• Maryport has a forward thinking general practice with strong clinical leadership
• The local community care passionately about Maryport Hospital – thousands mobilised to protest (Save our Beds campaign). A strong sense that the deprived areas always bear the brunt of any cuts and the better off areas are keeping their community hospital beds. 6000 have signed a petition.
The emerging model – 3 components
1. Shi ing as many of the 29,572 journeys back to Maryport as possible
2. Admission avoidance – acute hospital and residen al and nursing homes
3. Improving the popula on health – working with a community mobilised at scale, with schools and with community groups Maryport Hospital running 7 days a week but no overnight stay • This would release around £373,000 by not staffing evening and night shi s • We would reinvest this in bringing back as many of the 29,572 journeys back to Maryport • Merging the hospital and community teams and focussing on proac ve and reac ve admission avoidance • Funding some public health ini a ves e.g. with schools • Funding a doctor and increase pallia ve care nurse skills for the community team • Keeps the current budget in Maryport Co-produc on
A different way of thinking about how our public services are designed, delivered and evaluated.
It involves working in equal partnership with communi es where power is shared
Building partnerships, making services more effec ve and efficient, and in the long-term more sustainable.
Nesta has described it as ‘the most important revolu on in public services since the Beveridge Report in 1942’.
If star ng from conflict create ‘doors’ for people to walk through
Summary:
• We have tried to co-produce a be er solu on
• Based on a ‘whole place’ approach
• Built on assets rather than deficits
• Has the poten al to turn the energy of the protests into a community mobilised at scale for improved popula on health Lets create a ci zen led healthcare system
• Rebalance our accountability back to the communi es we serve
• Harness the power of people, pa ents, carers, communi es and ci zens to improve health – build a movement
• Ac vate individuals, ac vate communi es
• Move this from the periphery into the central DNA of our health system
• Lets make it the way we do things, our new paradigm, our response to the overwhelming challenges ahead