Developing the AHP Neuro Navigator in NWL – Lessons from Barnet Nadia Jeffries: Neuro-rehabilitation pathway co-ordinator for Barnet and Enfield and Jess Henderson ICHP6 July 2015

Example : trauma pathway diagram

The QIPP Challenge:

• There are 197 Level 1/2a Specialist Neurorehab beds across

London.

• There is a mismatch between demand and capacity for Level 1/2a.

• There is a shortage of Level 2 beds (77 across NWL, NCL and SWL)

• Long acute waits (median* 52 days from referral to admission) with

an average 95 number of patients waiting at any time.

• 2014/15: at any one time 13 patients recorded as Delayed Transfer

of Care to leave Level 1 units (NHSE 2015)

• 2014/15 approx. 5,400 bed days were lost in Level 1/2a units due to

Delayed Transfer of Care equivalent to £1.6 million cost to London

CCGs (NHSE 2015).

INNOVATION: Here is what the patients of North West London told us

4

We don’t think information is

exchanged across the

system about our care and

needs

As patients and families, we don’t feel we are kept up to

date on what is happening with

our care

We don’t think we get access

to all the services

available to us, because teams

don’t know what is

available in the system

We waited a long time to get access to

specialist neuro-

rehabilitation

We felt discharge

planning was not fully

considered

We think community and

voluntary services are available but we struggle to access them

Each injury is different, we need tailored

support packages to

help us recover

We need to get life back on track, this

means help with getting

into work and access to benefits

This event has impacted our families and

changed their lives, they need

help too

QUALITY: We see the neuro-navigators as key roles for alleviating some of the issues in the system

Advocate for patients and families and act as a ‘communication beacon’ between them and clinical teams

Understands the system complexities and how to leverage the services available locally

They will be a critical role within the MDT, proactively advising on how best the system can accommodate the patient needs promptly

Manages transitions between acute, specialist rehab and community discharge and accessing appropriate support services

Minimises delays and optimises rehabilitation outcomes by navigating the most appropriate individual patient pathway

5

The Barnet Experience: Innovation through the

Development of a District Level service

Case Management

Community Neurological Conditions Management

Team (including Vocational Rehabilitation)

In-patient condition

managementIn-patient

rehabilitation

Person Centred

Information Resource

Single point of access

Life long access

Productivity: Discharge from acute ward

• Economic impact analysis is challenging due to multi-factorial

influences on patient pathway.

• 2013/14 Barnet Neuro-navigator supported 29 patients. 19 patients

were transferred to Level 1 units (median waiting time 63 days (Min

6 to Max 117 days) and 8 patients re-directed to Level 2 unit

(Median waiting time 14 days).

• This equated to an average saving of 49 acute bed days per

patient and a total of 392 acute bed days equivalent to £81,312.

Productivity: Discharge from Level 1 to Community

• DTOCs from Level 1

units associated with

£1.6 million cost across

London CCGs (NHSE,

2015 ) *

• Possible correlation with

support from Neuro-

navigators -complex

analysis.

• Cost of 8a Neuro-

navigator: £60,500*

SE London

SW London

NE London

NW London

NC London

0

500

1000

1500

2000

2014/15 DTOCs (Bed Days) By CCG (NHS England 2015)

2014/15 DTOCs (Bed Days) By CCG (NHS England 2015)

SE London

SW London

NE London

NW London

NC London

00.5

11.5

22.5

33.5

Neuronavigators

Neuronavigators

* Ref : NHS Purchased Healthcare, 2015 Specialist centre delayed discharge improvement project output

Prevention and Sustainability

• Prevention of rehabilitation and health related secondary complications

associated with extended acute stays (often in non specialist

environments).

• New NN posts in NW London , Enfield CCG, Ealing CCG and SE London

supported by NHSE funding.

• 2015/16 : collaborative approach to data collection to improve economic

evaluation and document cost savings across NCL and NWL.

• Future developments: Joint review of patients within the community

supported by CHC has potential to prevent secondary complications and

achieve further cost savings.

Some ways we hope to measure success

Contribution towards NWL target of reduction of Delayed Transfer of Care by 85%

Patient satisfaction

Clinician satisfaction

Contribution to reduction in Average Length of Stay in Neuro-Rehab services

Influence on level of neuro-rehabilitation required

Suggestion for service improvement/ development

Reduction in referral time to assessment (target 7 days) – level 2/3

Reduction in referral time to admission (target 14 days)-level 2/3 10