mr chris hill torfaen joint intermediate care manager
TRANSCRIPT
Mr Chris Hill
TorfaenJoint intermediate
care manager
Encompasses a range of services managed within an established and co-ordinated system of care so that there is early engagement with need based on assessment and provision of multi-sectoral care.
What is Intermediate Care – NSF Wales 2005
DEFINITION
WHAT WERE THE DRIVERS?
Audit commission report (1997): The coming of age: Improving care services for older people.
There was too little investment in preventative and rehabilitative services leading to unplanned admissions of older people to hospital and premature admission to long term residential care.
Department of Health National Bed Enquiry (2000): Shaping the future of the NHS.
For Older people around 20% of bed days were probably inappropriate and would be unnecessary if alternative facilities were in place and close to home.
WHAT WERE THE DRIVERS?
NSF Older people England 2001 Standard three Intermediate Care
Department of Health (2002) Intermediate Care: Moving forward
Welsh Assembly Government (2001) – Improving health in Wales – A plan for the NHS with it’s partners.
WHAT WERE THE DRIVERS?
Welsh Designed for life
Welsh WANLESS report
Welsh Older Persons Strategy
Welsh Health Social Care and Well Being Strategy
Welsh Health Circular (2002) 128 – Intermediate Care guidance
Welsh NSF for older people 2005
INTERMEDIATE CARE
Acute Hospital Unnecessary Admissions
Inappropriate Bed occupancy(DTOC)
Right placeRight time
Right peopleRight service
INTERMEDIATE CARE
Facilitate Discharge
National Policy
TARGET GROUP
Service Primarily Directed to Elderly Care
65% of all hospital beds used by patients over the age >65.
Patients over the age of 75 use up 66% of the Social Services expenditure
75% of non-elective hospital beds used by the chronically ill.
Help prevention of deterioration and crisis To avoid inappropriate hospital admission To avoid inappropriate care home
admission Facilitate early discharge or transfer of
care to a more appropriate setting for rehabilitation
Maximise people’s independence Maintain independence
ETHOS:
ETHOS
We believe expansion of Intermediate Care is important to
the efficiency and effectiveness of the health andsocial care system. It will enable:
1. more effective use of acute capacity2. supporting targets on waiting times3. to respond more effectively to emergency
pressures4. more effective us of capacity in continuing
health care and long-term care as part of a wider set of measures to reduce dependency and institutionalisation.
Developing a service model
THE ACAT TEAMThe core team
Clinically led by a consultant geriatrician.1 SpR on training rotatation6 experienced clinical assessors2 skilled clinical support workersAdmin supportProviding a rapid response when needs arise.Deterioration in health or social circumstances.
Essential: 1. Rapid Assessment2. Diagnosis3. Immediate treatment4. Refer to the most appropriate services
THE WIDER TEAM
Reablement team PhysioO/TNurseCPNReablement assistantsCOPD/Respiratory servicesTele-health/care servicesEnvironment assessment and adaptations team.Falls servicesLong term conditions teamsEmergency care at home – social care service.And many morecollocated with a single point of contact.
WIDER TEAM NETWORKResponse times: Prioritise 1 12 hoursResponse times: Prioritise 1 12 hours
Prevent admission
Early discharge
Prevent admission tocare homes
Prevent admission
Early discharge
Prevent admission tocare homes
Sub-acute patients (Not acutely ill to be admitted to hospital)
VIRTUAL WARD ROUNDResident at own home, care homes orSheltered housing
DiagnosticsDiagnosticsGeneral Practitioner
IV antibioticsIV antibiotics
Out of HoursServiceOut of HoursService
Palliative CarePalliative Care
Minor injuryMinor injury
SINGLE POINT OF ACCESS
Assessors, Consultant GeriatricianSpecialist Registrar
REFERRING BODIESGPDISTRICT NURSESOCIAL WORKERHOSPITALTHERAPIST TEAMS
REFERRING BODIESGPDISTRICT NURSESOCIAL WORKERHOSPITALTHERAPIST TEAMSStep up to AdmitCountyStep up to AdmitCounty
DLN Facilitated DischargeDLN Facilitated Discharge
EMIEMI
Specialist NursesCOPD StrokeHeart Failure
Specialist NursesCOPD StrokeHeart Failure
Reablement Team
Emergency Social Care
VoluntaryServices
AmbulanceAdvancedpractitioner
At homeResourceCentre Beds
Day Care(Targeted)
BUILDING RELATIONSHIPS – JOINT SUPPORT
Acute Clinical Assessment Team
General Practitioners, Acute Clinicians, Allied Health and Social Care Teams, Care Homes, Voluntary Services, Supported Accommodation etc
TorfaenHospital Admission Avoidance Scheme
Steering Board
LHB, Trust, Social Service, GP, Consultant & Voluntary Bodies
Intermediate Care Directorate
Clinical Director, Borough Manager, Senior Nurse & Senior Social Workers
Co-Located Teams
REFERRAL & ASSESSMENT
GP’s Health and social care teams
Assessors carry out a full medical assessment including all appropriate diagnostics. (Rapid access)
All patients are part of a virtual ward and are discussed with the consultant regarding interventions, risk and treatment plans
GP’s fully aware of contact, interventions, treatments and discharge planning arrangements.
Clinically GP’s remain responsible for their patient.
Delivery of Clinical Futures
(Reduction of acute beds) TRANSFER
Creation of virtual beds and ward in the Community
Problem:IncreasingemergencyadmissionElderly
Problem: DTOC
Delayed discharge(old and very
old) “Blocked
Beds”
Responding to PressureResponding to Pressure
Torfaen GP Admissions >75 yearsVariances between Jan-Aug 2006 – Jan-Aug 2007
OUTCOMEOUTCOME
GP ADMISSIONS
Jan-Aug 2006 Jan-Aug 2007
6.30pm-9am 241 129
9am – 6.30pm 441 211
Source of admissionJan-Aug
2006Jan-Aug
2007 Variance
A&E 646 406 -240
GP 682 340 -342
Other 64 34 -30
Total 1392 780 -612
THE FINANCIAL POTENTIAL GAINS
Admissions
saved from
January 2007 –
April 2008
LOS Bed days x cost Cost for NHS
bed occupancy
Cost of ACAT
Team
Variance
1 Day 975 x 262 £255,450 £455,690 - 200,240
2 days 975 x 262 x2 £510,900 £455,690 + 55,210
5 days 975 x 262 x5 £1,277,250 £455,690 + 821,560
10 days 975 x 262 x10 £2,554,500 £455,690 + 2,098,810
12 days 975 x 262 x12 £3,065,400 £455,690 + 2,609,710
15 days 975 x 262 x15 £3,831,750 £455,690 + 3,376,060
WHOLE SYSTEM APPROACH
LOCAL INTEGRATED PLANNING/COMMISSIONING/EVALUATION
Primary CareLHB/PCT
Secondary Care
Social Care Intermediate Care
Voluntary Care
Thank you for your kind attentionPlease do not hesitate to contact either Chris Hill – Joint intermediate care
[email protected] 332377Professor Bim Bhowmick – Consultant
Geriatrician and clinical director for Torfaen intermediate care services on 01495 765712