CCG Delivery Day HomeFirst Update Chris Badger Assistant Director for Health and Social Care Integration

Lower Lea Valley HomeFirst Update

Referrals into HomeFirst – Weighted rate per 1000 population compared with emergency admission rate (ages 65+) Some practices are referring almost half what Warden Lodge and Maples is referring based on weighted population. Doesn’t seem to be any correlation between referral rate and admission rate.

Virtual Ward 96.5% of referrals seen within 1 hour Virtual Ward Statistics   Nov-12 to Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 TOTAL Case Management Admissions 983 71 56 53 41 66 1392 Discharges 879 43 78 46 61 63 1269 On Ward at Month End 104 132 135 113 120 100 123 Average Length of Stay 44.6 47.1 43.2 52.5 72.9 66.0 47.0 49.0 Rapid Response 426 24 30 21 32 23 601 416 31 27 22 26 596 10 3 12 9 8 6 5 14.3 9.1 14.8 9.4 8.8 8.3 12.1 12.9 Occupied Beds at Month End 118 147 122 128 106 96.5% of referrals seen within 1 hour

Impact on secondary care

Impact on secondary Care – A&E Lower Lea Valley initial pilot monitoring based on projected levels Projected levels using a decomposition method to take into account both trending and seasonal patterns via MedeAnalytics. This applies to all projections used in the following charts.

Impact on secondary Care – A&E Lower Lea Valley initial pilot monitoring based on projected levels

Impact on secondary Care - Emergency admissions Lower Lea Valley initial pilot monitoring based on projected levels

Impact on secondary Care - Emergency admissions Lower Lea Valley initial pilot monitoring based on projected levels

Impact on secondary Care - Emergency admissions Activity pre and post Homefirst (12 months)

2% reduction in ambulance conveyances Impact on secondary Care Change in the % of ambulance conveyances post Homefirst commencing 2% reduction in ambulance conveyances Useful or delete?

No change in % of ambulance conveyances to total A&E Impact on secondary Care Change in the % of ambulance conveyances post Homefirst commencing No change in % of ambulance conveyances to total A&E Useful or delete?

Impact on secondary Care – A&E Lower Lea Valley monitoring based on statistical process control (SPC)

Impact on secondary Care – A&E comparison with other localities, monitoring based on statistical process control (SPC)

Impact on secondary Care - Emergency admissions Lower Lea Valley monitoring based on statistical process control (SPC)

Impact on secondary Care - Emergency admissions comparison with other localities, monitoring based on statistical process control

Quality

83% (HCT overall 77%)

96.36% Harm free care

North Herts HomeFirst Update

Referrals into Homefirst – Weighted rate per 1000 population compared with emergency admission rate (ages 65+)

Virtual Ward 96.5% of referrals seen within 1 hour VIRTUAL WARD STATISTICS   Jul-14 to Aug-14 Sep-14 Oct-14 Nov-14 TOTAL Case Management Admissions 70 72 97 66 376 Discharges 34 64 83 318 On Ward at Month End 107 115 129 Average Length of Stay 50.5 47.9 39.0 41.0 43.4 Rapid Response 50 73 63 45 302 41 59 40 283 24 38 29 9.8 12.3 9.4 12.8 10.9 Supported Discharge 26 33 39 31 200 22 32 192 7 11 12 7.1 9.0 6.5 7.4 Whole Service Occupied Bed Days 5871 4046 4791 4659 19367 Occupied Beds at Month End 138 164 170 174 96.5% of referrals seen within 1 hour

Impact on secondary care

Impact on secondary Care - Emergency admissions North Herts year on year weighted rate per 1000 population

Impact on secondary Care – A&E North Herts monitoring based on projected levels

Impact on secondary Care – Emergency Admissions North Herts monitoring based on projected levels

Supported Discharge

DISCHARGES FROM SUPPORTED DISCHARGE BROKEN DOWN BY DISCHARGE DESTINATION Lavender Rose Total %age Care Complete 5 8 13 10.7% Case Management 36 20 56 46.3% Core Team 6 18 24 19.8% Hospital 10 8.3% ICT Bed   3 2.5% Nursing Home 2 1.7% No Destination 4 9 TOTAL 65 121 100.0% Supported Discharge Jul-14 to Aug-14 Sep-14 Oct-14 Nov-14 TOTAL Average Length of Stay 7.1 9.0 6.5 7.4

Quality

(includes whole locality) 80% Trying to see if we can extrapolate the HF data from the localtty data. (includes whole locality)

93.44% Harm free care

Next steps Promotion across practices Care Homes Mental health integration Health psychologists and self-management Supported discharge audit