Urgent Care Planning in South Tyneside David Hambleton Urgent Care Everyone’s problem

Urgent Care Plans Urgent Care – –Everyone’s problem so nobody’s problem Why is it a problem –High A&E attendances but –Low admission rates –Lots of people in A&E who needn’t be

Percentage of A&E Attendances converting to Admissions 3

Over-crowding in A&E Why it’s a very bad thing After admission through a crowded A&E 43% increased chance of dying at 10 days A&E stay of 4-8 hours increases inpatient length of stay by 1.3 days A&E stay >12 hours increases inpatient length of stay by 2.35 days

What can be done prior to A&E GP Access Quality Premium (GP QOF) –Ambulatory Care Conditions –A&E usage Anticipating urgent care demand Improved care in nursing homes STICS - better management of LTC RAID - rapid, effective and safe access to mental health services

What can be done in hospital Ambulatory Care Conditions pathway GP in A&E? White board system to track patients Review spilt of beds between medical and surgical specialties Rapid response clinics Psychological liaison service within an Urgent Care hub

Discharge & out of hospital care Hospital discharge process and communication ‘Time to think’ beds Single point of contact for social care Reviewing current provision of self management education and support

NHS 111 update National free-to-call memorable number Single point of contact for urgent care ‘Talk before you walk’ NE system is working (unlike others) Teething problem being ironed out Opportunities still to be realised

NHS 111 update Patients directed to right services, first time Directly booking appointments into services – including GPs Better use of community services Indentify where gaps in service are

Shared Care Plans Self Care Supporting older people at home Crisis Acute setting Step down Supporting older people at home Self Care STICS (COPD) Programme for implement STICS (COPD) Nursing home SLA/ LES Community matron as care coordinator (evaluation) Telehealth/ wound sense DNs/ flu vaccines Zoning of Urgent Care nursing teams ACS Pathway review Single point of contact social care IRT Discharge process Discharge Communication PPP patients Time To Think beds Dementia Step up facilities Perth Green STICS (COPD) Nursing Home SLA/ Spec Pulmonary Rehab Cardiac Rehab Pulmonary Rehab Cardiac rehab *Primary care *Primary Care *Community nurses (map which teams) *A&E *Local Authority *Community nurses (map teams) * Hospital staff * SW team * LA * FT *Primary Care *Community Nurses (map which teams) Teams involved Tools Risk stratification - (in use in a fragmented way, i.e. separately in FT and Primary Care); not yet in use in LA = opportunity to streamline, agree consistent cohort? e.g. at risk of admission Standard Care Plan – opportunity Standard work – across the pathway for this group involving teams and shared understanding, + time based standards = opportunity (see Nottinghamshire work in progress on frail elderly pathway care standards) *Rehab teams DRAFT URGENT CARE SYSTEM MAP – South Tyneside Urgent Care Delivery Group

Round Table Discussion On your tables you will be asked to consider: Are we on the right lines with our plans? What else should we be thinking about doing?