Commissioning alternatives to hospital Dr Seth Rankin



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tarix05.01.2018
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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!



A new way to structure Community Service.

  • 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.



Hospitals

  • Hospitals

  • Acute & Chronic Patients

  • A&E, MAU, Inpatient, etc

  • MDT Ward Rounds

  • Bedside & Paper

    • Nurses
    • Doctors
    • Social Workers
    • Pharmacists
    • MDT input


Improve patient’s experience and increase capacity for home-based healthcare

  • 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.



Daily ‘activity rounds’ with core team

  • 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







Patients prefer to be at home.

  • 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?



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