Integration to avoid hospital admission: ITHAcA Sarah Purdy on behalf of the HIT

Health Integration Team modus operandi of Bristol Health Partners What is a HIT? Health Integration Team modus operandi of Bristol Health Partners Should: improve outcomes across the patient pathway create an integrated whole health system approach promote research disseminate innovation and evidence align with education/training

ITHAcA Aims to reduce avoidable hospital admissions across BNSSG increase enablement of patients and carers reduce complexity in urgent care system develop capacity to use data and evaluate changes optimise productivity and efficiency of existing and new interventions Includes all BHP partners plus BCC and collaborators SP

Address priorities for BHP NHS outcomes framework – reducing emergency admissions adults and children Highest bed days for LTCs in South West Admissions for COPD 25% above average Rising population over 65 years of age - pressure on social and health care Acute services redesign and integration priority for NHS partners JU “Admissions should be appropriate, focused and effective”

Challenges in urgent care: diagnosis simplify systems in and OOH match demand and capacity expert early assessment reduce LOS in bedded settings address needs of high risk populations JU - DH Emergency Care Intensive Support Team

Urgent care potential work streams Key Urgent care potential work streams Operating Principles End of Life Care planning Preventative Escalation 1st June priority - top Prevent 1st June priority - next Public comms – GP 24/7 Urgent care centres – location and spec NHS111 & Directory of services – avoid multiple SPAs Directory of Emergency Ambulatory Care/Hot Clinics (Professional SPA link) Simplify Existing work streams Other Healthy Futures project/programme Protocol for ambulance management of HCP calls with referrers Match demand and capacity 7 days a week Connecting Care – integrate information Mental Health Liaison Front Load Create Reliability See and Sort Early senior review at first point of contact Benefits measurement – balanced scorecard approach Minimise time in bedded settings Invest in discharge enablers JU Cultural enablers Flow Enablers Focus on reducing LOS – pull from front door, pull from back Address financial disincentives through tariff changes and/or budget integration Advice & Guidance Urgent category transport (same day, 1 hour) Alternatives Enablers Evidence-base – Health Improvement Teams/Partnership integration

Evidence based strategy targeting four areas Using data to inform commissioning Model patient flows – system dynamics Risk profile severity at presentation Increase understanding of triggers for admission using qualitative methods and case studies Evaluate new interventions – start with NHS 111 Childhood asthma Model patient flows Inform development of interventions HE Lots of data but lack of information Admissions not reducing in line with anticipated benefits from local interventions JSNA identified lack of intelligence around children's admissions

Evidence based strategy targeting four areas Dementia and intercurrent illness Ensure appropriateness of admission and discharge Increase understanding of burden on carers with aim of increased support at home and reduced long term care placement Develop living environments to sustain people with dementia who wish to live in the community COPD Optimise productivity and efficiency of existing interventions Introduce and evaluate new evidence based approaches HE

Improving and integrating COPD care Improve utilisation of smoking cessation Map services Increase pulmonary rehab uptake Severity at presentation Acute admission prevention strategy JC Model flow Evaluate BTS care bundles at NBT Exemplar for other conditions Short term 1-3 years

Other components of a COPD acute admission prevention strategy Medium term (3-6 years) Longer term (5-10 years) Intensive education in self management with follow up Earlier diagnosis Increase expertise amongst community staff New models of specialist/GP working JC Specialist led care for all admissions Develop and pilot new interventions

ITHAcA strengths Strong existing links between senior individuals in all partner organisations around the problems to be addressed + underpins existing mechanisms Expertise in research, clinical, social care and organisational development Links to: existing PPI groups other proposed HITs Pilot work to develop initial project funded and potential programme manager in post SP - mention other collaborators – BCH, GWAS, BrisDoc Other HITs

ITHAcA challenges and opportunities Potentially huge agenda but a priority NHS reconfigurations and reforms Need for whole system changes and buy in Robust evaluation has resource implications NIHR HS&D Research Programme calls: New models of care for LTCs EOI Jan 2013 Sustaining impetus – HIT longevity an opportunity SP