The Care Debate: an NHS provider perspective Dr Ros Tolcher Chief Executive, Harrogate and District NHS Foundation Trust National Care Association Symposium Thursday 5 th March 2015

The context in which health and social care is provided is changing. What challenges do we face and how is Harrogate NHS Foundation Trust responding to these?

HDFT provides hospital services, and community services….

Hospitals are facing big challenges due to growing demand and budget constraints….

Each year, the Trust has more than a million contacts with patients and their families…….

…..for example during last year Our surgeons performed 27,500 planned operations There were 250,000 outpatient appointments Our emergency department and minor injuries unit saw more than 66,300 people There were 17,700 emergency admissions to the hospital Our district nurses made more than 90,000 visits Our health visitors completed more than 110,000 contacts Our podiatry service had more than 100,000 contacts across the county We provided care from around 130 sites as well as in patients’ homes

The population we provide care for is changing

We have a high proportion of older and very old people 70% of over 65s have one or more LTC The over 65 population is growing faster than any other It is now the norm for people to have multiple long term conditions in later years

The cost of providing health care is rising, but the funding we receive for care is falling…. £ Cost of care funding £30 Billion

So we need to provide more for less…... How are we doing this?

Healthcare provision has been dominated by primary care (GP practices) and hospital based care… ??? ….even though people’s needs often sit between the two and you can’t easily distinguish between a health need and a care need

We know that many people could remain safe and well at home with the right support Approx. one in five admissions to the hospital are clinically avoidable

….and many people remain in hospital longer than they need to. Nearly 60% of people in hospital beds could have their needs met in a non-acute environment

In fact, the people who least need to receive care in an acute hospital bed often stay there the longest A greater proportion of admissions on Saturdays are avoidable, but these patients go on to have a longer hospital stay Many people with ‘avoidable admissions’ have a ‘care need’ rather than a healthcare need

In Harrogate and rural district, health and social care providers are working together to deliver new models of care….. ……designed more closely around the needs of local people, and offering better value

Our goal is to deliver a comprehensive, integrated care model where…. Prevention, self-care and independence are the bedrock Peoples’ needs take precedence over organisational boundaries Our local health and social care system is clinically and financially sustainable People and their carers are partners and are involved in planning their goals and care needs

To do this, we will need to…. Fill the space between the GP surgery and the hospital with a comprehensive, integrated locally based service including nurses, doctors, social workers, therapists, pharmacists, mental health workers The voluntary sector has a big role to play Enhance health care in-put to nursing and care homes

To do this, we will need to…. Work with local patients and their families and carers Make better use of technology Agree a single assessment process and a single, shared patient record Invest in more staff working in the community Manage ‘flow’ through the hospital better Introduce more Extra Care housing

Putting people at the centre Community Hub Single point of access for health, social care and voluntary sector Health Hub Integrated health and social care teams Step up/step down beds Emergency hospital beds

Thank you for your attention Questions and discussion