Developing the model of care July 2018

Welcome and Introductions The national picture Why we need to do things differently Addressing the challenges and developing a new way of working (model of care) Your thoughts What happens next

The NHS is facing significant challenges Nationally, stories are shared daily highlighting the ongoing challenges for hospitals, their staff, patients and the public. Rising demand and a shortage of specialist staff together with rising costs means it will be increasingly challenging to provide safe and effective care and treatment on time for our local communities. Unless we change how our hospitals work, more people will wait longer for treatment, and the quality and safety of care will deteriorate.

A collaborative programme… Our Health Our Care A collaborative programme… Prevention and Early Intervention Out of Hospital In Hospital

Why we need to do things differently…

Some of our biggest challenges Number of people over the age of 65 needing complex care set to increase by 33,000 by 2037 Large gaps in medical staff and a national shortage of specialist staff including nurses and doctors A&E 4-hour performance achieved 60% of the time, against the national standard of 95%

Some of our biggest challenges If you live in the most deprived areas of central Lancashire you are 51% more likely to die from cancer or a stroke High cancellation rates due to lack of critical care beds and other factors impacting on Cancer waiting times Despite these challenges, there are lots of examples of high quality and innovative care being provided by our staff Planned surgery is being cancelled due to busy wards and increased demand. People are waiting longer for treatment

Examples of high quality care TIA (Transient Ischaemic attack) Clinic TIA is also known as a ‘mini stroke’ Clinic established to offer out-patient care 7 days a week Consultant led service means a prompt review and treatment from senior clinician One stop shop for patients who would have previously been admitted to hospital Patients receive in-depth diagnostics and commence medication to prevent a further attack Ambulatory Emergency Care Established at the Chorley site Whole system approach, with both hospital and GP/Community based care Service led by senior clinicians who will undertake initial assessment, diagnosis and treatment on the same day, with ongoing clinical follow-up as required Proving successful in providing rapid treatment and ongoing support which prevents people from being admitted into hospital unnecessarily

Examples of high quality care Cancer Nursing The team in our chemotherapy day case unit have been shortlisted for a national Nursing Times award in the category of “Cancer Nursing” for their work to improve experiences for patients Over the past 12 months, the service has been expanded to provide care closer to home, including opening a chemotherapy unit at Chorley Hospital Patient Safety Improvements The Nutrition Nursing Team have been shortlisted for a national award for their work to develop a whole system approach to improving safety using small feeding tubes, used for short or medium term nutritional support. Their work includes implementation of an e learning tool and has been shared as a free resource which a large number of other NHS organisations have now implemented. Health Education England has also adopted it as a national programme of education.

We want to learn from what we are doing well and do more of it by developing new ways of working We need to make sure our services are sustainable for the future and can tackle the challenges we face

Working with our staff and clinicians Doctors, Nurses and other clinical staff with expertise in these areas, started by identifying the main problems with the current system and the things that stop patients from receiving the best care They then developed possible ways to tackle these problems to improve patient care, treatment and outcomes and deliver services that are safe, high quality and clinically and financially sustainable We also gained input from patients and partner organisations across the health and care system

Developing a new Model of Care These ideas have been brought together in an emerging ‘model of care’. Which is an outline description of how services may be structured and delivered differently in the future A model of care describes how care can be provided not where it can be provided The emerging model of care developed by clinicians does not name sites and could be delivered on a number of separate sites or all located on one site It is guided by a number of principles

Model of Care Guiding Principles Patient Centred Care Supports safe, quality care for patients Improved access to services Ability to measure how well we are doing Standardised treatment and outcomes Encourages Innovation Supports efficient use of resources Supports integrated care

Our clinically-led emerging Model of Care Single emergency and major trauma centre, delivering high quality emergency medical care 24/7 Single access booking and streaming of patients A co-located Urgent Care Treatment Centre and a networked Urgent Care Treatment Centre Standardised Ambulatory Care Unit(s) Centralised, fully equipped Critical Care Unit. Planned Care Centre with protected beds to prevent cancellations Joined up pathways of care between Primary Care and the Hospital Frailty Assessment Unit or enhanced virtual Frailty Assessment across Central Lancashire Integrated partnership care with specialist support and advice to GPs and teams wrapped around the patient Enablers such as IT and digital to transform services and support care closer to home

5 areas of hospital care in focus 1. Acute Medicine - Immediate and early treatment by specialists, within the first 24 - 48 hours of being admitted to hospital 2. Critical Care - Specialist care for patients whose conditions are life-threatening and require constant monitoring. Also known as intensive care 3. Surgery - Planned surgery procedures, carried out as a day patient or requiring a hospital stay 4. Speciality Medicine – Patients who are admitted to hospital as their care is likely to exceed 72 hours. Treatment of conditions affecting vital organs such as heart, lungs, kidneys, nervous system etc. or conditions such as cancer and diabetes 5. Emergency Care and Urgent Care - Emergency care for people who have life or limb threatening problems; and Urgent Care provided for illnesses or injuries that needs prompt attention but are not life or limb threatening

Acute Care

Verbal prompt: Early specialist review , quicker decision on test results, early test availability , lesser time off work and convenient predictable schedule despite unplanned admission. Less chasing up for urgent tests . No unnecessary stay in the Hospital.

What does it mean for me as a patient? You will receive the right care at the right time and in the right place You wont wait as long for appointments and surgery You will be less likely to be admitted into hospital as you will receive care closer to home You will spend a shorter amount of time in hospital You will receive high quality care from clinical experts You will have your planned surgery on time, and it won’t be cancelled because the hospital is too busy Your experience of the care and service you receive at hospital will improve

Your thoughts In your table groups: 1. Do you understand this model? 2. Do you think this will help address the challenges we face? If not, why not? 3. Is there anything missing?

What happens next…

Next steps We will be sharing the information you have heard this evening throughout the coming weeks, speaking to staff, community groups and key stakeholders, and on tour with the Healthwatch ‘chatty van’. The slides will be on www.ourhealthourcarecl.nhs.uk along with a questionnaire so you can tell us what you think Feedback gathered during these engagement events will be shared with the clinical steering group and fed into the model of care, which will then be finalised. We will then bring the model of care, estates, finance and workforce information together to develop a number of different ways the finalised model of care could be delivered in the future This model of care and how it could be delivered will then be shared during formal consultation in the New Year. We will be speaking to you again in the next few months

Share your experiences Please take a survey to fill in or you can follow the link to complete it on line… https://www.surveymonkey.co.uk/r/ourhealthourcarefeedback

Chorley House, Centurion Way, Leyland Contact us Tweet us @_OHOC Like us @OurHealthOurCareCL www.ourhealthourcarecl.nhs.uk/ 01772 214323 ohoc.enquiries@nhs.net Chorley House, Centurion Way, Leyland Lancashire, PR26 6TT