feedback summary the feedback from the public events which took place in march (in addition to other...

Feedback SummaryThe feedback from the public events which took place in March (in addition to other ongoing stakeholder and public feedback) were summarised and used to inform the thinking in Workshop 5a; this was in addition to the ‘Community Hub’ visions that were created by the Community Hub Groups. Whilst both elements do not explicitly relate solely to the bedded care element; the value of the feedback we have captured and used in our approach is provided to give greater context .

North Derbyshire21C #JoinedUpCare

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Stakeholder Feedback and ‘I’ StatementsThe feedback and ‘I’ statements are based on what people told us as being important to them and has informed the development of the options.

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Stakeholder Feedback

General feedback about the Programme•Support for the thinking and agreement that this is a good concept;•Progress needs to be communicated effectively in plain English and without the use of jargon;•Build on the good examples that have shown positive outcomes already;•Some cynicism as it feels like this has been looked at several times – this time there appears to be real commitment and buy-in from all of the partners;•Need to ensure we have the right resources with the right skills located in the right place

Access•Improve access to GP services and well advertised alternatives;•Promote the use of pharmacies and voluntary sector;•Care and support to be available at the right time, not just “office hours” and at weekends;•Support one stop shops including mental health, children, self help, voluntary sector, wellbeing / health promotion;•Care to be provided in or as near home as possible;•Ease of access, parking, public transport – this also applies when needing to go further afield for appointments•Praise for achievements and plans / concern about adult care

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Stakeholder Feedback

Continuity and information sharing•Care wherever provided must be safe, provide continuity and be based on shared information / records;•Single point of contact for patients and support for enhancement of care-coordinator role;•Professionals should be sited together and share best practice;•Improve discharge, communication and overall co-ordination – including nursing and residential homes;•All stakeholders including patients, professionals and carers should have timely access to the right information;•Ensure robust security and governance of data and patient records

Efficiency•Efficient use of assets and buildings, able to change and grow over time;•Need to take account of future housing plans and growth predictions in the planning of services;•Support use of technology including on-line self management tools and video-conferencing (Skype);•Ensure there is provision for those who do not have internet access or do not wish to use this channel of communication;•Support specialist sites offering services across wider area;•Pool resources – if lose services, explain alternatives / benefits;

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‘I’ Statements

Community Hub- options workshopFebruary 2015

6Confidential for use by Community Hub Working Groups

Our care system will be designed to meet the following expectations…

When I need care…

If I have ongoing care needs…

When I need help urgently or in an emergency…

If I need help which can be planned…

Based on the combined views of patients and clinicians and consistent with national and local guidance…

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When I need care…

• I do not want to repeat my story unnecessarily

• I expect to be treated as a person, not a collection of illnesses or body parts

• I expect me and my family to be supported by a caring team working together

• I want to be cared for as close to home as possible

• I expect my information to be shared appropriately amongst professionals to improve my care

• I want easy to use aids and devices to help me care for myself

• I expect services to use technology to help me get the advice I need when I need it

• I want my care to be communicated in a language I understand with minimal jargon

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If I have ongoing care needs…..

• I want to have control of the care I receive - to be supported to live well with my long term condition(s)

• I want people to be respectful of my family’s knowledge about me

• I expect to plan my care with people who work together to listen to me and my family

• As a result, I have a plan of care based on my personal needs and aims

• I want to be well informed and aware of the services available to support me in staying well

• As a younger person, I will be supported through the change to adulthood in a joined up way that meets my needs

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When I need help urgently or in an emergency…..

• I expect a timely same-day response

• I will be assessed simply and quickly irrespective of time of day

• I can access whatever services I need (physical health, mental health and social care) 7 days a week

• Whoever sees me will have access to information about ongoing needs so I get the right help

• Wherever possible, I would like to be looked after locally – I only want to go to hospital if absolutely necessary

• People will work together with me and my family to support my return home as soon as possible

• I need the right teams working with me to help me get better at home

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If I need care which can be planned…

• I would like it to consider all of my care needs – coordinated and located to keep my travel and number of visits to a minimum

• I expect a high standard of care and to be sure that I am not disadvantaged by where I live

• For more specialist services, I understand that I may need to go further to see the right person or for the right equipment

• Where possible, I would like a single point of access for all of my care provision

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Public Event Feedback

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Public Feedback – Key themes

Access•Improve access to GP services and well advertised alternatives;•Support one stop shops including mental health, children, self help, voluntary sector, wellbeing / health promotion;•Care to be provided in or as near home as possible;•Ease of access, parking, public transport; •Praise for achievements and plans / concern about adult care;

Coordination•Care wherever provided must provide continuity and shared information / records;•Site professionals together / share best practice.•Improve discharge, communication and overall co-ordination – including nursing and residential homes;

Efficiency•Efficient use of assets, able to change and grow over time – don’t forget housing plans;•Support use of technology;•Support specialist sites offering services across wider area;•Pool resources – if lose services, explain alternatives / benefits.

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Public Feedback - Key themes Geographical Community SpecificGC2Good & Bad experiences in GP services: • In my practice we made a call urgently at the end of the day and the

GP/nurse waited to see the patient before going home.• Don’t go and see my GP now anyway – know won’t get an immediate

appointment – use nurse or 111 or go to A&E.

Communication Needs for Deaf patients – there needs to be some kind of phone service for deaf people – with 999 a deaf person can register as a text. Can this be done for 111?

Urgent Response • Don’t mind who I go to as long as dealing with my condition,

particularly medical condition;• If it’s an emergency happy to go anywhere

Location of service• Can we use community centres, leisure centres;• Do it locally in a less threatening place more local;• It all comes down to Trust in the people providing advice.

Integrated care – integrated services in a community – around patients• Reablement brilliant but when 6 weeks finished – services withdrawn• Hillstown – Valley view – to offer services – Bolsover Hospital• Sherwood Ward – Differing Agencies to congregate people with LTCs• Bolsover Community Hospital – Ideal Hub Site• Possibility of urgent care usage at Bolsover /2.30 / 5.30 bus to

Bolsover Community Hospital• See Shirebrook / Cresswell/ Whitwell separate to Bolsover

GC1

•Transport links are a key aspect for GC1; Should consider local bus service before deciding where hubs are

•No direct bus service to CRH or Sheffield hospitals

•Patients from Gosforth Valley Medical Practice gave example of receiving information by text; which was thought to be a good idea

•“Dronfield School had a programme where pupils went into The Green” (local care home) and taught the residents how to use technology” – the group liked this idea and thought it could be extended.

•One of the group identified the need for a Community Hospital in Dronfield, however the rest of the group had concerns over the cost and benefits this would offer.

•People in Dronfield measure their facilities against those provided in Clay Cross, where they are better, many are bitter about this”.

•“Dronfield has much less bedded care than other areas of north Derbyshire”.

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Public Feedback - Key themes Geographical Community Specific

GC3 & GC4Support for the recognition that Chesterfield is 2 distinct communities - Smaller villages/areas of East Chesterfield are very tight knit communities – Brimington very different to Staveley and one community may not want to visit the otherYour community is where you can get to which is different dependant on mobility.CRH is a place that people in East Chesterfield recognise and see as theirs/in their community.•Recognition of all the joined-up work already being done and the positive outcomes of this;•Concerned that we give equal regard to MH and not just dementia or physical health;

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Public Feedback - Key themes Geographical Community SpecificGC6•The specific needs of rural communities and access issues must be taken into account•Use existing NHS buildings but be more flexible about their use their special status•Dales have ‘orphans’ – old people retire to the area and lose a partner. often living in inaccessible areas/homes – children move away and leave parents and one dies •Older people retire to the Dales and are often living in inaccessible areas/homes, and very isolated. Therefore we need somewhere for people to meet together! •Transport Networks across Dales is terrible. Transport issues over border especially from Dales villages to Sheffield is not easy.•Mobile Phone signals can be poor in some parts of the Dales & High Peak; need to take into account in new technology approaches• Good idea of using teleconferencing facilities and/or Skype

from the Whitworth to speak with Specialist doctors; • Like electronic patient records to be accessible by all

healthcare staff to ensure effective treatment

Patients long term needs are best assessed at home • Need to assess that the home is suitable from the outset to

anticipate any problems re discharge; • Patient’s own bed at home should become the ward where

care is delivered

Use of buildings/estate • The group queried the role of the community hospital. How can

services be more adaptable to wrap services around the patient rather than be dictated by architecture?

• Not just community hospitals we could also rationalise general practice, pharmacies, ambulance stations. Are these buildings fit for purpose?

• Keep MIU at Whitworth• Community beds for the surrounding community rather than

relatives travelling ( e.g. Grindleford – Clay Cross)• Crich has a great community hub. There is a GP and pharmacist

within it but also groups eg a befriending service Models – • Would like the Manchester model of funding for Dales!• Wheatbridge model is good , pharmacies, drop in etc, tests on

the spot• Nottingham model – Two tier service established whereby

patients with long term care requirements were seen by one service and therefore had continuity of care and patients needing one off appointments were seen by another team

• The Wimbledon community model was also mentioned whereby children are also involved who will then carry on the community model in adulthood.

• Ringing only one number was not a popular model around the table as people want to speak to a decision maker not a trained layperson and people questioned whether algorhythms used by call handlers is the most appropriate model? They can be very frustrating for the patient/carer calling in.

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Public Feedback - Key themes Geographical Community Specific

GC7 & GC8•Continue working with the District Council on appropriate projects e.g. falls and housing related issues;•Work closely with Stepping Hill not just CRH – keen for more Consultant OPD outreach;•Cross border initiatives in general should be improved e.g. discharge arrangements, equipment availability, transport arrangements;•Address EMAS, and phlebotomy service issues;

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Community Hubs Vision Summary

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System Integrated Care is seen as being at the heart of the Community Hubs vision; building on “what is good already”; there are “people, skills and infrastructure to achieve this so there is no need to change the world”. The hubs should enhance and learn from this and provide a focal point from which everything is coordinated; for all people and professionals. This includes the full spectrum of health, social care and well-being (physical, mental, social and voluntary services which support the whole spectrum); the concept of whole system, whole person (multi-disciplinary; multi-agency) at all levels. Professionals need to be “…mutually accountable clinically to their team” regardless of their organisation. Concept The hubs would have a ‘community role’ as “in the sense of fulfilling a community role - this is reinforced & contributes to the development of community resilience”. The hubs would not only support ‘ill-health’ but play an active part in the wellness of the local community (preventative approach); creating a sense of responsibility and ownership for taking care of ourselves and each other. The sharing of information and approach could “form part of a new social contract between citizens and health and social care. This new social contract would also involve a number of responsibilities on citizens as well as rights”.The concept in whatever shape or form it eventually takes on needs to “..facilitate the ‘community hub’ as a way of doing business”.

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The Community Hubs are seen as providing a vital coordination role; this is in terms of care, sharing information (between professionals and for citizens), and shared records. Co-location of teams will improve coordination and communication. This coordinating role will also provide the added benefit of reducing duplication; whilst improved communication amongst all involved will enable better decisions to be made so everyone involved knows what each other is doing. The citizens will be able to make more informed decisions and choices about their health and well-being; professionals are better informed of the ‘full picture’ in relation to individuals and aware of other services/support that is required and can access these better. The coordination role extends to ‘sharing’; this includes information but extends further through the knowledge, skills, and resources that can be shared between professionals and education of citizens. The hubs need to be coordinated around the needs of the local population. Flexibility The hubs will need to be flexible and adaptable to changing needs and requirements of the community it serves; they will also need to be organic in the way they evolve. “Hubs must be flexible in what they set out to do now and in the way they sense and respond to changing needs in the future. What they must have is the mechanism to make that flexibility and responsiveness a reality”. The flexibility also applies to the way in which the hubs work; for instance services in a physical building with co-located staff, mobile workers outwith in the community.

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Cultural shift There is recognition that for community hubs to genuinely become a reality they will need to be based on more than “relying on goodwill and vague notions of partnership working” and this will require strong leadership and shared values. Strong and vibrant communities will be required to make this happen which need a significant cultural shift from all perspectives; “the primary changes of genuine integrated care are not structural but cultural. “Ask not what integrated care can do for you but what you can do for integrated care”. There is a strong desire and need to create the culture which supports the Community Hubs; this cultural/ mind-shift will be necessary to ensure “alignment of organisational values, staff mind-sets and cultures”…so that “… historic barriers can be overcome.” People and professionals will need to create a culture which engages new ways of working and thinking; based on collaboration between individuals and organisations. “What we now need is nothing less than a cultural revolution in which we not only accept more responsibility for ourselves but take on responsibility for others”. “…given the will and imagination, hubs could provide a once-in-a-generation chance to help bring about a much needed cultural change ('I am primarily responsible for my health') and help bring about a radical improvement in the health of the nation (as distinct from being preoccupied with its ailments).” Relationships The Community Hubs will be based on strong relationships; between the people using in the hubs and the professionals they interact with; between all the professionals working there (regardless of organisation) and amongst the people themselves by creating the sense of ‘community’. Those relationships need to be supportive; people are supported to take care of themselves and professionals are supported to enable that. It is important that the hubs facilitate greater interaction amongst the people using and working there as “...relationships and good coordination will be key to success.”

Configuration There is no specific distinction between a physical building or having a more virtual ‘network’; there is merit in a combination of both. Some services/clinics would need to be delivered from specific sites but the concept is broader and needs to be supported by the wider network of ‘JoinedUpCare’ providers working proactively together to wrap around the local people. “…the hub needs to have a physical presence for people to fully appreciate its worth.” “Likewise many professionals will not be working in the hub but will be out in people’s homes when providing care but it is their physical and emotional link back to the hub.” “A hub’s physical presence will therefore reflect this and will be inclusive, it will be sited and developed in a way that engages the population and allows those with the burden of illness to feel that they still have a role in society and are of value.” “…it is a network of care providers who proactively work together to achieve all the critical components of person-centred coordinated care.” “…IT networks; professional relational networks; connected facilities and resources that deliver health & social care to people.” This could also extend to community transport networks. Primary Care should be the foundation for the hub network; with its role enhanced. “To make this real there should be one single telephone number”; the hubs would be accessed via a single point (telephone number, font door) and a centralised appointment/booking system would facilitate flow; avoiding referrals back to GPs so that the process becomes genuinely seamless. The hubs would provide “…a collection of services which can be accessed via a single point.” This would enable coordination “…to a wider system of care including GPs, community nurses, CPNs, etc.... depending on need.”

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Functions There will be a variation in the size and scope of the services available from the physical hubs (e.g. some offering urgent care and/or bedded care facilities); this will be dependent on scale. Ultimately the physical aspects would be connected through the network; with no boundaries. The hubs should support 7 days a week care, with universal availability extended to 8pm/10pm; there is recognition that there is insufficient demand to warrant everything being available into the night. Citizens would be taken care of and interact predominantly by the community hub; and specialist services would be accessed outside of the hub for specific needs and for short periods of time. Examples of the kind of things which could be provided from the hubs:Dementia cafesSign-postingHealth coachingHealth & social care informationVolunteering postsSocial meeting areas (reduce exclusion, learning opportunities and build confidence etc....)Links with wider services e.g. HousingLunch ClubsSocial Clubs (e.g. art)Near Patient TestingClinicsMobile/ Occasional services (e.g. screening)Minor injuriesMother and Baby clinicsSexual Health Health Promotion (e.g. Stop Smoking services)Advocacy and advice Physical activities e.g., (wheel) chair based games, gentle exercise, dancingProfessional education, mentoring and training

‘Feel’ The Community Hubs would be friendly, accessible, approachable, reassuring, informative, responsive, supportive, recognisable, easy, and trusted; for both the people it serves and the professionals within it.There will be a ‘community centre’ feel.

What is Community Hub?

It is a gateway for connecting multiple services together

and making them act as a single network, for everyone in the community.

It It strengthens the community capacity to

promote and sustain health, ensuring responsible use of

resources

IIt enables all health sectors to share

knowledge, expertise and information

Empowers participation from

residents into decision making

There is a LIVE control centre that adapts to the needs of the community

Inspires patients to take control of their own care.

Easy access

It allows reduced protectiveness of our professional role. We do what we need to meet the needs of the patient within our competencies. Assists right

care at the right time and place.

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A Story which captures the essence of what has been described…. My name is Stan I live in a small hamlet on Tideswell Moor – I am 84yrs old & a retired lead miner – I have diabetes, only take tablets, but I have also started being a bit confused & I go out and walk a lot – walk to the shops in Tideswell, walk to the surgery in Bradwell & walk &sometimes I forget why I have gone out & where I was going! I catch the bus sometimes. I have 2 daughters, 2 sons & loads of grandkids – but I don’t see them very often apart from Liz who lives in Wardlow – she does some shopping for me & pops in every week. I live alone – my wife died a few years ago. The house is a bit of a mess but I like it like that – they wanted me to have a home help but I refused. I often go to the “community hub” in Tideswell – they have set it up in the church hall. I get my lunch there once a week – a man comes in his blue BMW to fetch me & he takes me home if it’s cold or raining & I don’t want to walk home. Ladies from the village cook lunch – I pay £2. But the nurse is at the hub & she tests my blood for the sugar in my blood. I have also seen the podiatrist there who checks my feet are ok. Last year there was a van there & a few of us had our eyes photographed. There is a lot of information in the hub – leaflets to stop smoking, loose weight etc.... if I need to see the doctor the nurse will sort it for me. The GP surgery is next door to the hub & I get my tablets from there as well. Last summer – I was doing some gardening & I cut my arm on some barbed wire that I have to keep the sheep out of the garden. It was bleeding quite a lot. I went to the house next door – the man there took me in his car to the hub. At the hub the nurse put 2 stitches in my arm & gave me an injection. The man next door was on his way to Sheffield – so the min-bus that they use to pick people up to take them to hospital took me home. They also use the mini-bus to pick me up & take me to the day centre on a Friday at the hub. We do art work, have lunch & we see old photos of the area & then they take me home.

The week after I cut my arm, a nurse from the hub came to see me at home & took the stiches out.

At the hub I have also seen that mums & babies are there on a Friday afternoon – I think they have their babies weighed there.

A few weeks ago my daughter brought the shopping over one evening & she asked me why I was hot & mixed up about things – I had let the fire go out & I was cold. She rung up & they made me an appointment to see a special nurse at the hub. When we got there; there were a few people waiting to see the special nurse. I only had to wait 15 minutes & I was seen. It was a male nurse & he was great – he checked my blood pressure, my pulse & breathing – they were all ok. He pricked my finger & put some blood in the machine – my sugar was low. He told me to go & have a cup of sweet tea & a biscuit at the hub café – I felt ok after that & made an appointment for me to go to Buxton for an X-ray. The mini-bus picked me up the following day from home & took me to Buxton hospital. At Buxton I had an x-ray – that is where I see the specialist that looks after my diabetes. They call the place at Buxton the Buxton Hub – it is bigger than the hub I go to & has more clinics there & the hospital is in the same place. When I was having my cup of sweet tea I was chatting to some young people who were there. They told me they had been to the “clinic” – I think it is what we used to call the family planning clinic when I was young! Since they have opened the hub at the church hall I don’t see the doctor at the surgery as much as I used to – they look after me at the hub. I am writing this in the sitting room at the Community Care Centre that the council built in the village last year. What happened as that I went for a walk one evening last winter – it had been frosty & I slipped over on the road close to the house. One of my neighbours found me & took me to hospital in Sheffield. They told me I had cracked a few ribs falling – they sent me to the CCC for a few weeks. The CCC is over the road from the hub & I have been seeing the Physio & OT & my ribs are better now – I am going home next week & they have arranged for me to have a home help twice a week. I am really well looked after – the hub is great – my daughter says I would have been in a home ages ago if it was not there.

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So what is a community hub?

In summary a community hub is a place or places where:•Joined up out of hospital services are provided•The care delivered meets the needs of local communities•Services are local to where people live•Care is provided for all ages•Teams work together to provide co-ordinated care (physical, mental health and social care) •Technology is used where it helps people access services and information more easily

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So what might community hubs ‘look like’…

Urgent care-Primary care-UCC-…

Bedded Care-At home-‘Extra care’-Condition specific?

Planned / Integrated Care-Clinics

Voluntary-…

Social Care-…

Community centre-…

Education-…

Generic-Children / families-Adult-Elderly

Specific-Ongoing care needs-(top 5-20%)

feedback summary the feedback from the public events which took place in march (in addition to other...

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