1 Commissioning Update Supporting Admissions Avoidance and Effective Discharge October 2013 Board of Governors Report Fareham and Gosport CCG South Eastern Hampshire CCG Portsmouth CCG

Key Messages ■There has been good progress in developing out of hospital health and care services in Portsmouth and South East Hampshire ■The introduction of 111 and the re-procurement of OOH service has created some demand, this is benchmarked to be significantly lower than that experienced nationally ■The growth in ED attenders does not appear to be higher than many other Acute Trusts. Seen an increase in the number of minor conditions not requiring admission ■Whilst there is more to be done, the local health system performs well in supporting the admissions avoidance and discharge of patients ■The community is complex with a number of partners who have developed excellent relationships with each other, acute and the commissioners. 2

Statistics ■The number of trust wide non-elective admissions have reduced by 3% compared to last year (currently 5% below plan). This compares to a national trend of 0.5% growth (SUS data) ■Between 2007 and 2012 emergency admissions grew by only 3% compared to 25% across the South of England and 29% across SHIP (Kings fund review urgent and emergency care) ■Higher % of 0-1 day emergency admissions than SoE average, but a significantly lower % of emergency admissions with LOS over 7 days. (Kings fund review urgent and emergency care) ■The Trust has the second lowest % of bed days lost to delayed transfers of care of all acute Trusts across Hampshire, Dorset, Surrey and Sussex (1.02% of bed days lost against an average of 2.51%) (SUS data) 3

4 Discharges Delayed Transfer of Care Guidance The national definition states that the delayed transfer of care occurs when a patient is ready to depart and is delayed. A patient is ready for transfer when: A clinical decision has been made that patient is ready for transfer AND A multi-disciplinary team decision has been made that patient is ready for transfer AND The patient is safe to discharge/transfer Delayed Transfer of Care Guidance The national definition states that the delayed transfer of care occurs when a patient is ready to depart and is delayed. A patient is ready for transfer when: A clinical decision has been made that patient is ready for transfer AND A multi-disciplinary team decision has been made that patient is ready for transfer AND The patient is safe to discharge/transfer Medically Stable Discharge Ready Patients (MSDR) The relevant Consultant Team has deemed the patient no longer requiring an acute hospital bed. All tests required as an inpatient and that may affect the medically stable status have been completed Medically Stable Discharge Ready Patients (MSDR) The relevant Consultant Team has deemed the patient no longer requiring an acute hospital bed. All tests required as an inpatient and that may affect the medically stable status have been completed

5 Who Provide Services in the Community? Solent Healthcare Trust provide Community Nursing, Therapy, Mental health and End of Life services to Portsmouth City and Southampton City residents Southern Health Foundation Trust provide Community Nursing, Therapy, Learning Disability, Mental Health, and End of Life services to all Hampshire residents (5 CCG’s) and a walk in centre at GWMH Care UK provide minor injuries units and walk in centre, diagnostics, Ultrasound, X-ray and ECHO, Day surgery, orthopaedics, ophthalmology, general surgery and gastroenterology and run a diabetic retinopathy screening program at St Marys, Portsmouth and a GP surgery and walk in centre at Guildhall walk Domiciliary care services provided by Hampshire and Portsmouth County Councils South Central Ambulance Service provide NHS 111 HDocs provide out of hours services Third Sector providers (Macmillan, Rosemary Foundation, Rowans, plus others)

6 Community Beds PortsmouthHampshire Spinnaker WardSolent16Rowan WardSHFT20 Jubilee HouseSolent25Cedar WardPHT22 LongdeanSolent10Sultan WardSHFT21 Harry SotnikPCC10Ark RoyalPHT18 Eden ValeSHFT10 Cams RidgeGPA6 Wenham HoltGPA4 Re-ablement (various Nursing homes) HCC24 Across Portsmouth and South East Hampshire there are a total of 152 Community Hospital beds provided by SHFT, Solent and PHT and 34 Re-ablement/CHC beds provided by HCC and PCC

Work Streams to Support Admissions Avoidance (1) Urgent Care Centre will be starting on 1 st November 2013 – 4 days a week moving to 7 days within 2 months GP in ED pilot commenced March / April 2013 NHS 111 provided by SCAS UK OOH Service provided by Care UK/Hdocs Ambulatory Care Centre increased provision to 7 days a week from January 2013 and will introduce 6 new pathways on 11th November 3 Minor Injuries Units and walk in centres (GWMH, St Marys, Guildhall) Community Assessment Lounge commenced April 2013 Community ED Team commenced 2012 GP non conveyance SCAS provide a “safe place” at Guildhall at weekends for substance misuse

Work Streams to Support Admissions Avoidance (2) 9 Community Care teams providing virtual wards supporting patients in their own homes 3 Rapid Assessment Units in Hampshire 1 Day Hospital in Portsmouth Specialist Care Home Matron Team providing training and education to care homes across all 3 CCG’s Specialist Falls Teams, 3 Falls Co-ordinators being piloted in 3 localities Specialist Heart Failure, Diabetes and Respiratory Teams Specialist Continence, Palliative Care and Safeguarding Teams

Primary Care Engagement Incentivising GP’s to provide additional medical support to nursing homes Incentivising GP’s to register and treat patients who have fallen and have a previous fracture Re-viewing all current LES schemes GP’s will be at the heart of the Integrated Community Care Teams supporting community teams to keep patients at home longer Practices are providing telephone triage and extended hours

10 Work Streams in Development to Support Admissions Avoidance Development of Integrated Community Care Teams (4 pilots have started) Review of whole end to end Older persons pathway to develop an integrated whole system pathway focused on any patient with complex co-morbidities Reduction in LOS of Community Hospital Beds to increase throughput for step up patients Development of 7 day community services 7 day Psychiatric Liaison Team in ED Review of Dementia Services

Work Streams to Support Effective Discharge Increased access to CHC Fast Track – reducing the number of CHC delays Community in reach (Pull) discharge team commenced 7th October Focus on delivering an integrated approach to discharge for all complex patients over 18 years old Led by Community Matron Includes Occupational Therapy, Physiotherapists & Social Care links OPMH Liaison Team commences 29 th October Focus is rapid specialist assessment and treatment of people with mental health problems in QA Led by Nurse Team Leader Includes 8 PA’s of medical time Dedicated CHC nurse based in PHT 5 days per week from November 2013 Non Weight Bearing Pathway – Commenced January 2012

Work Streams in Development to Support Effective Discharge additional discharge to assessment beds to be opened in Hampshire to support CHC patients Review of End of Life Services Review of Community Bed Provision across Portsmouth and South East Hampshire Introduction of 7 day imaging

13 Any Questions? Contact: