NHSI - Criteria Led Discharge Case study: Oxleas NHS Foundation Trust Dr Derek Tracy, Consultant Psychiatrist & Clinical Director Oxleas NHS Foundation Trust, London Senior Lecturer, King’s College London

Overview of presentation Background: the landscape in mental health Recent work: rationalised admissions, facilitated discharges Current work, future plans: better commissioning & data-sets

Background 1948, NHS founding, 50% of beds were mental health From over 250,000 then….

An enormous need to rationalise our inpatient services: 3% of our patients 50% of our budget Increased scrutiny of: Rationale for admission Duration of stay for those in hospital Delays in discharge Move away from: Medic-led decision making Discharge-when-well to discharge-when-well-enough

Recent work: being strategic about discharge

On the way out as soon as you’re in Before/at admission: - Reason for admission - Outcomes from admission - Predicted LOS for these - Clear diagnoses & medicines - Factors likely to delay discharge Initial ward assessment: - MDT Team agrees LOS & plan - 1˚ nurse ‘how can we get you home’ - Housing: probs identified - Who is at home who can help? - What will help them get home? During admission, info: - ‘what to do to get well when home’ - Any medicines/changes - Date of OPC & review - Physio/AHP inputs as IP/OP - ‘how to keep your spirits up ‘ - websites for peer support

Current work, future plans Reducing admission rates: targeting ‘problem groups’ Crisis cafes: late opening, non-medicalised environments, reducing ‘crisis admissions’ Day Treatment Services specifically helping crisis planning Work with the police & their High Intensity Network Reducing duration of admission: better data sets A chronic, critical problem in MH – what to measure? We’ve digitised clinical and psychosocial outcomes into EPRs Monitor individuals, units/teams, strategically map services

NHS Benchmarking data, 2016, from acute Trusts

National Audit Office: “Representative care journey of older person”

Strategic integration with social care + =

Questions? derek.tracy@nhs.net With thanks to Geraldine Strathdee