Welcome to the new acute and community

County Durham and Darlington NHS Foundation Trust

Clinical strategyFT member events

April 2011

The new Foundation Trust…• …an acute and community Foundation

Trust for County Durham and Darlington• …more integrated, better co-ordinated

care for patients• …helping the health and social care

system work together more effectively• …opportunities for staff working in new

and different ways

Trust governancePublic

governorsStaff

governors

Governing Council

Stakeholder governors

FoundationTrust Board

Clinical vision – an opportunity

“to shift the centre of gravity from hospital to community and

develop fully integrated care pathways”.

Clinical vision• Premier provider of healthcare in County Durham and

Darlington including:– Prevention and enablement– Community Services– Planned and emergency hospital care

• Major provider of women’s and children’s services in the North East

• Reputation for excellent specialist services• National profile as a pathfinder for new ways of offering

health services in hospital, home and community

Clinical strategy – our aims• The best health outcomes for patients• An excellent patient experience• High quality, low cost services for

commissioners

Clinical strategy – key areas

Long term conditionsCare of older peopleWomen and children

Acute medicine and emergency careSurgery

End of life care

Case study – long term conditions

Case study – long term conditions

Long term conditions• Quick win: Facilitated discharge, good referral guidelines for

disease progression, pathway for minor acute events, access to specialist support 0900-1700 via bleep and phone line (being set up now),

• Priority issue: Patient education, equity of care, community clinics across the county, decrease LOS in surgical patients (CQUIN), IT - common LTC pathway and paperless clinics with instant transfer of data across primary and secondary care

• Synergy benefits: – Outcomes and experience: reduced admissions through better

accessibility to specialist staff, better screening and management– Workforce: development opportunities working across the pathway

utilising district and community nurses and integrating them with hospital specialist nurses

– Efficiency: Community rather than hospital follow ups; Nurse rather than Consultant follow ups. Working along with other workstreams - old age/ emergency and end of life care pathways to be put in place

Older people• Quick win: Dementia – training of all staff who are in

contact with older people through e-learning etc• Priority issue: single point of access to range of

services• Synergy benefits:

– Outcomes and experience: Early prevention /screening, future care planning

– Workforce: better use of specialist skills through dedicated specialist direct assessment /admission unit

– Efficiency: better use of community hospitals

End of Life• Quick win: Use of DH ‘surprise question’ as a trigger

into advanced care planning in the last year of life• Priority issues: Shared, real time access to information

via IT systems; single point of access in the form of a coordination centre

• Synergy benefits: – Outcomes and experience: patients more likely to

access preferred option/place of care at the end of life– Workforce: developing skills to facilitate patient choice

of preferred place of care at the end of life– Efficiency: reduce number of avoidable admissions to

acute care at the end of life

Acute medicine emergency care• Quick win: integration of protocols between UCC and A&E• Priorities: joined up approach with all stakeholders including

NEAS, social care

• Synergy benefits: – Outcomes and experience: reduced waits by quicker access to

appropriate level of care – Workforce: access to senior experienced clinician opinion at

earliest opportunity in the pathway– Comprehensive directory of supporting services in community and

acute settings – Efficiency: reduced admissions from ED and urgent care

Women’s and children’s• Quick win: Antenatal assessment for vulnerable

families• Priority issues: Middle grade cover in paediatrics

and maternity, training of advanced paediatric nurse practitioners, consultant numbers in paediatrics

• Synergy benefits: – Outcomes and experience: Community care pathways for

women with low risk pregnancies – Workforce: Alignment of community midwives with integrated

children’s teams– Efficiency: integrated Health Visitors and school nursing

children’s teams with social care

Surgery• Quick win: Redesigning pre-operative pathway; changes to

urology pathway• Priority issues: Addressing pressures in vascular surgery• Synergy benefits:

– Outcomes and experience: more accessible service for patients, reducing unnecessary hospital visits ( pre-operative pathway), delivery of care closer to home (Urology pathway).

– Workforce: changes to skill mix to meet pathway requirements, staff have the skills to deliver care in the appropriate setting for the patients

– Efficiency: Reducing emergency admissions to hospital. Offering other services to manage surgical emergency activity, to deliver a better service for patients.

Clinical strategy - discussion • What services could be offered in the

community that are currently offered in hospital?

• Delivering services in hospital– Advantages– Disadvantages

• Delivering services in the community– Advantages– Disadvantages

We are developing a new clinical strategy for the new organisation

Take part in the discussion atwww.cddft.nhs.uk/about-us/clinical-strategy.aspx

Any questions?