BERKSHIRE WEST urgent & emergency care system 7 PILLARS OF URGENT & Emergency care

Context Achievement of A&E 4 hour constitutional standard Key themes Gateway letter from Simon Stevens and Jim Mackey March 17 Actions to get A&E performance back on track Achievement of A&E 4 hour constitutional standard 90% by Sept-17 95% by Mar-18 (linked to STF funding) Key themes Freeing up hospital bed capacity Managing A&E demand Aligned national support and oversight

7 PILLARS OF URGENT & EMERGENCY CARE - BW SELF CARE MINOR ILLNESS/INJURY ACUTE/LIFE THREATENING REHAB & MAINTENANCE 111 Online 111 Calls/ Clinical Hub GP UTCs SCAS (ARP) Hospital Hospital to Home Online symptom checkers TV IUC Urgent Care Hubs Review of WIC Nature of Call ED life saving skills Trusted Assessment Online triage Call handler to clinician ratios/Warm transfer rates Streaming in ED Designation of existing facilities Despatch on disposition Streaming - Ambulatory care D2A No decision in isolation Expansion of access Core standards See and Treat Streaming – Frailty Care sector and market management Telemedicine Link with Primary Care hubs Hear and Treat SAFER and Red2Green BCF and DToCs Review of green ambulance and ED dispositions Clinical triage Integrated Discharge hub Choice policy IPS EDDs and clinical criteria for discharge CHANNEL SHIFT HIGH INTENSITY USERS ‘CARE SPACE’ MODELLING

NHS 111 NHS 111 Online NHS 111 Calls National ask Where are SCAS? Evaluation and implementation 17-18 Intelligent personalised triage 18-19 30% shift phone to online access 19-20 Where are SCAS? Reviewing available online tools Fast follower What are the gaps? National decision Technology connections National ask 30% calls referred to clinical triage by Mar-17 50% by Mar-18 Where are SCAS? 20% referred currently 30% in IUC procurement What are the gaps? Clinician workforce Reporting changes

7 PILLARS OF URGENT & EMERGENCY CARE - BW SELF CARE MINOR ILLNESS/INJURY ACUTE/LIFE THREATENING REHAB & MAINTENANCE 111 Online 111 Calls/ Clinical Hub GP UTCs SCAS (ARP) Hospital Hospital to Home Online symptom checkers TV IUC Urgent Care Hubs Review of WIC Nature of Call ED life saving skills Trusted Assessment Online triage Call handler to clinician ratios/Warm transfer rates Streaming in ED Designation of existing facilities Despatch on disposition Streaming - Ambulatory care D2A No decision in isolation Expansion of access Core standards See and Treat Streaming – Frailty Care sector and market management Telemedicine Link with Primary Care hubs Hear and Treat SAFER and Red2Green BCF and DToCs Review of green ambulance and ED dispositions Clinical triage Integrated Discharge hub Choice policy IPS EDDs and clinical criteria for discharge CHANNEL SHIFT HIGH INTENSITY USERS ‘CARE SPACE’ MODELLING

Ambulance (SCAS) Ambulance Response Programme Right vehicle, right skills, right time every time National ask Enhanced see & treat and hear and treat by Mar-18 ARP roll out by Oct-17 Ambulance workforce development by Dec-18 Where are SCAS now? ARP impact assessment underway Workforce development underway Hear & treat rates 10% vs target 20% See & treat rates 36% vs target 40% Challenges Clinician workforce Hear and treat rates

7 PILLARS OF URGENT & EMERGENCY CARE - BW SELF CARE MINOR ILLNESS/INJURY ACUTE/LIFE THREATENING REHAB & MAINTENANCE 111 Online 111 Calls/ Clinical Hub GP UTCs SCAS (ARP) Hospital Hospital to Home Online symptom checkers TV IUC Urgent Care Hubs Review of WIC Nature of Call ED life saving skills Trusted Assessment Online triage Call handler to clinician ratios/Warm transfer rates Streaming in ED Designation of existing facilities Despatch on disposition Streaming - Ambulatory care D2A No decision in isolation Expansion of access Core standards See and Treat Streaming – Frailty Care sector and market management Telemedicine Link with Primary Care hubs Hear and Treat SAFER and Red2Green BCF and DToCs Review of green ambulance and ED dispositions Clinical triage Integrated Discharge hub Choice policy IPS EDDs and clinical criteria for discharge CHANNEL SHIFT HIGH INTENSITY USERS ‘CARE SPACE’ MODELLING

Hospital – new Streaming Model New streaming model to be operational from Oct-17 (dependent on outcome of capital bid) ACS workstream to “right size” bed capacity across acute and community sites ED freed up to focus on life threatening and complex conditions Internal Professional Response standards and “Next Steps” approach

7 PILLARS OF URGENT & EMERGENCY CARE - BW SELF CARE MINOR ILLNESS/INJURY ACUTE/LIFE THREATENING REHAB & MAINTENANCE 111 Online 111 Calls/ Clinical Hub GP UTCs SCAS (ARP) Hospital Hospital to Home Online symptom checkers TV IUC Urgent Care Hubs Review of WIC Nature of Call ED life saving skills Trusted Assessment Online triage Call handler to clinician ratios/Warm transfer rates Streaming in ED Designation of existing facilities Despatch on disposition Streaming - Ambulatory care D2A No decision in isolation Expansion of access Core standards See and Treat Streaming – Frailty Care sector and market management Telemedicine Link with Primary Care hubs Hear and Treat SAFER and Red2Green BCF and DToCs Review of green ambulance and ED dispositions Clinical triage Integrated Discharge hub Choice policy IPS EDDs and clinical criteria for discharge CHANNEL SHIFT HIGH INTENSITY USERS ‘CARE SPACE’ MODELLING

Hospital to Home Where are we now Priorities for 17-18 RBFT DToC rate 5.53% (Mar-17) vs target of 3.5% equating to >1000 beddays lost Reading most challenged performance in 16-17 but improving trend Capacity constraints in the care sector BCF schemes firmly embedded and reviewed for effectiveness as part of 17-18 planning Priorities for 17-18 8 High Impact changes for DToCs Trusted Assessment Discharge to Assess Integrated Hospital Discharge Hub Locality BCF schemes Rapid response and reablement Discharge to assess facilities (including Birchwood Care Home in Newbury) Integrated Hubs

7 PILLARS OF URGENT & EMERGENCY CARE - BW SELF CARE MINOR ILLNESS/INJURY ACUTE/LIFE THREATENING REHAB & MAINTENANCE 111 Online 111 Calls/ Clinical Hub GP UTCs SCAS (ARP) Hospital Hospital to Home Online symptom checkers TV IUC Urgent Care Hubs Review of WIC Nature of Call ED life saving skills Trusted Assessment Online triage Call handler to clinician ratios/Warm transfer rates Streaming in ED Designation of existing facilities Despatch on disposition Streaming - Ambulatory care D2A No decision in isolation Expansion of access Core standards See and Treat Streaming – Frailty Care sector and market management Telemedicine Link with Primary Care hubs Hear and Treat SAFER and Red2Green BCF and DToCs Review of green ambulance and ED dispositions Clinical triage Integrated Discharge hub Choice policy IPS EDDs and clinical criteria for discharge CHANNEL SHIFT HIGH INTENSITY USERS ‘CARE SPACE’ MODELLING

Primary Care Access - Current State 275 WTE GPs 50 practices across 4 localities South Reading: Alliance working Wokingham: Developing similar alliance working model with four emerging clusters N&W Reading/Newbury – first steps to developing new models of care using learning from South Reading and Wokingham Working across Practices and sharing staff e.g. Clinical Pharmacists/physiotherapy AQP Access to full range of community services via the Health Hub (SPA) Increased use of digital technology e.g. ICE pathology system and connected care Reading Walk-in Centre Registered list size of 7,526 (January 2017) Walk-in contacts 34,901( March 2016 to February 2017 Discussions underway regarding future provision